PHARMACOLOGY UNIT 1 EXAM
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- WHAT ARE THE GENERAL PROPERTIES OF DRUGS?
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1. Do not confer new functions on tissues or organs
2. Usually exert multiple actions
3. Drug actions result from an interaction between the drug and a molecule in the body - What should you do if you cannot read a physician's handwriting?
- We should call the physician for clarification before administering the drug
- Persons with liver and or renal failure will probably have problems with which steps of pharmacokinetics?
- Metabolism (liver failure) Excretion(renal failure)
- Name the 5 components of the nursing process?
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1. Assessment
2. Nursing diagnosis
3. Planning
4. Implementation
5. Evaluation - Discuss ASSESSMENT-the first part of the nursing process.
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Initial step-appraisal of a pt's condition (ongoing process) that involves gathering and interpreting data.
i.e. contraindications, allergies, drug-drug, drug-food, alcohol use, caffeine etc - Discuss the NURSING DIAGNOSIS-the second part of the nursing process.
- A clinical judgement about individual, family or community responses to actual and potential health/life processes-provide a basis for selection of nursing interventions to achieve goal
- Discuss PLANNING-the third part of the nursing process.
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After determining appropriate nursing diagnoses-2 steps:
1. setting goals (outcome criteria)
2. listing interventions (what to do to meet the goals) - Discuss IMPLEMENTATION-the fourth part of the nursing process.
- Doing what we planned to do to achieve the outcomes. I.E. all the steps of med administration, collaborating with prescriber, 6 r's, giving med, education
- Discuss EVALUATION-the fifth part of the nursing process.
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2 parts:
1. Evaluate your performance along every step of the process
2. Evaluate the client's response to the med or method - What does NPO mean? Why is it important when your pt needs oral medicines?
- "Nothing by mouth". We should know if they are about to enter/leave surgery or about to have a diagnostic procedure that does not allow them to ingest anything
- Why do we use nursing diagnoses?
- Nanda nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable
- When and how must we identify a pt. if giving meds?
- Every time. We should check the ID bracelet and match it with the order and we should also ask their name
- Name the 6 r's of medication administration?
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1. patient
2. medication
3. dose
4. route
5. time
6. documentation - What are drug prototypes and why are they important?
- A model drug to which other drugs in a pharmacologic class may be compared.-Lets you know something about an unfamiliar drug in the same class
- Why is the subject of medication errors so important?
- All nurses have potential to make a med order. The error needs to be revealed as we are keeping in mind the welfare of the PT-especially younger and older ones
- Discuss drug schedules.
- The are restricted by the Controlled Substances Act and have a strong potential for abuse I highest abuse potential, II high, III moderate, IV lower, V lowest
- Who can prepare a medication which you are going to give?
- We should (sometimes pharmacy)
- Discuss necessary components of medication orders.
- Must be written to be legal, phone order prescribers must come in to sign, must be specific-not vague
- When should we do PT. teaching regarding meds?
- Every time we give it
- When can we give a particular medication in regards to the time ordered?
- 30 minutes before up until 30 minutes after
- What is the effect of food given with most medications?
- Coats the stomach and reduces gastic upset
- Name some drug-drug interactions. Differentiate.
- Synergism, potentiation, antagonism
- What is bioavailabilty?
- Ability of a drug to reach its target cells and produce its effect
- What are analgesics? What are the three main categories?
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Drugs that relieve pain
acetaminophen *tylenol, aspirin, and NSAIDS - What are some components of Tylenol?
- Most common; Analgesic and antipyretic properties; no anti-inflammatory properties; can cause serious liver or kidney damage if abused
- What are some components of Aspirin?
- Very old med; Antipyretic,(reduces fever) Anti-inflammatory; Analgesic; Anti-platelet activity(thins the blood)
- What are some side effects associated with aspirin use?
- GI upset, nausea/vomiting,(most common), heartburn, ulcers, GI bleeding, tinnitus, allergic reactions
- How can most problems with taking aspirin be alleviated?
- By taking the med with food or a full glass of water, or one can take enteric coated aspirin
- Name some drug-drug interactions with aspirin.
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ASA & Coumadin (blood thinner/asa can cause bleeding)
ASA & Lasix (diuretic) can cause nerve damage
ASA & Vancomycin
Enteric coated ASA & Antacids (acuses the coating to dissolve) - What is Reye's syndrome and who could be affected?
- Serious neurological condition that can occur if a child under age 18 takes aspirin during or following an acute viral infection. Children under 18 should not take aspirin
- Name some components of NSAIDS.
- Non-steroidal anti-inflammatory agents, have all 3 actions: analgesic, anti-pyretic, anti-inflammatory, all were originally prescription drugs *motrin-ibuprofen and Aleve
- What are some side effects of NSAIDS?
- Nausea or vomiting, cramps, diarrhea, gas, possibly ulcers and GI bleeding
- Name some components of antacids.
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May be taken before or after meals, combination antacids decreases the constipation or diarrhea caused by single agent antacids
maalox, mylanta, gelusil(some take them as a laxitive) - What is Simethicone?
- Is an anti-flatulent and an ingredient in some combo antacids. Pure simethicone is Mylicon
- What are some types of laxitives?
- Saline, stimulants, bulk-forming lubricants, emollients (fecal moistening agents)-stool softeners, sufactants colace
- What are some factors of anti-diarrheal agents?
- They only take care of symptoms-not cause, no proven therapeutic benefit, types: absorbents and synthetic opoids (they are locked in narcotic drawers)
- What are some properties of cough medications?
- Treats non-productive, dry, irritating, and prolonged coughs. Secondary to treating the underlying disorder
- What are some types of cough and cold medicines?
- Antitussives (agents that suppress cough), Antihistamines (seasonal allergies), Expectorants (will bring up whatever is in the bronchials) Decongestants and combination
- Discuss the elderly in regards to drug levels.
- Changes in pharmacokinetics, increased gastric ph-more alkaline, decreased 1stpass in liver(metabolism)more meds in body, less water, renal function
- List the 5 pregnancy categories.
- A, B, C, D AND X
- Explain a category A for pregnancy.
- Adequate, well-controlled studies in pregnant women have not shown an increased risk of fetal abnormalities
- Explain a category B for pregnancy.
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Animal studies have shown no adverse effect, no well-controlled studies in preg. women
or-animal studies have shown adverse effect-but studies in preg women have not - Explain a category C for pregnancy.
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Animal studies have shown an adverse effect-no studies in women
or-no animal studies have been done and no studies in women - Explain a category D for pregnancy.
- Studies in pregnant women have demonstrated a risk to the fetus-benefits may outweigh risks
- Explain a category X for pregnancy.
- Sudies in animals or women have demonstrated positive evidence of fetal abnormalities. Containdicated.
- What should be included in Pt. teaching about herbal preparations?
- Impress upon them the importance of letting a doctor or nurse know what they are taking to avoid drug interactions, be skeptical of claims, we should not condemn
- What are nurse an integral part of emergency preparedness programs?
- They have a unique body of knowledge and the ability to use critical thinking and make plans
- What is the role of the CDC in emergency preparedness?
- CDC-CENTERS FOR DISEASE CONTROL AND PREVENTION-informs, educates and prepares the public to disease outbreaks
- What info should the general public have regarding viral attacks, storing meds etc?
- Keep immunizations current, no effective means to fight many substances such as viruses and radiation
- What is pharmacology?
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A science that studies drug effects within a living system
central focus is to improve the quality of life - What are three 3 categaories of therapeutic substances?
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1. Drugs or Medications (prescription or OTC)
2. Biologics
3. Alternative or complementary therapies - What is the function of the FDA?
- Drug regulation, must give approval before a new drug is available, keeps unsafe or ineffective drugs from market, removes drugs, oversees info and herbal prod.
- How are drugs classified?
- By their Therapeutic or Pharmacologic classification
- What are the 3 types of drug names?
- Chemical assigned by the International Union of Pure and Applied Chemistry, Offical (generic name) assigned by the U.S. Adopted Name Council, Trade name assigned by the company marketing the drug 17 years exclusive rights (proprietary name)
- What does the Nurse Practice Act cover?
- states what we can and cannot do, each state has an NPA, contains the definition of professional nursing, controlled by BNE (state board of nursing)
- What are the 3 broad categories of drug routes?
- Enteral, Topical, Parenteral
- Define pharmaceutics.
- study of the ways in which various drug forms influence pharmacokinetics and pharmacodynamics
- What is pharmacokinetics and what are the four steps?
- The study of drug concentrations during processes of: 1. absorption 2. distribution 3. metabolism and 4. excretion
- What are some varibles that affect absorption?
- Nature of cell membrane, blood flow to site of administration, solubility of drug, ph, drug concentration, drug form and route
- Define distribution.
- Transport of a drug in body fluids from bloodstream to various tissues of body and ultimately to its site of action.
- What are 2 components of drug pooling?
- plasma protein binding and tissue binding
- What are the 2 barriers to distribution?
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1. Blood-brain barrier
2. Fetal placental barrier - Define metabolism.
- The process of chemically inactivating a drug by converting it into a more water-soluble compound or metabolite that can then be excreted from the body
- What are some variables in metabolism?
- Cardiovascular disease, hepatic disease, renal problems, immature systems, degenerative enzyme functions
- What is the Hepatic 1st Pass Effect?
- Meds administered orally will be absorbed from the GI tract and will go to the liver first before going into general circulation
- Name some of the sites for excretion.
- Kidneys-primary organs, GI tract, sweat and salivary glands, mammary glands, hemodialysis and peritoneal dialysis
- What is pharmacodynamics?
- the sudy of the mechanism of drug action on living tissue, or the response of tissues to specific chemical agents at various sites in the body-the effect the drug has on the body
- What is the mechanism of action?
- Thw term given to the means by which drugs change a function of tissues or organs, drug-receptor interactions, drug-enzyme interactions, non-specific
- What do blood serum levels tell us?
- If an adequate amount of the drug is in the system
- What is a half life?
- The time needed to decrease by half the amount of unchanged drug in the body at the time equilibrium is established
- What should we remember about the half life of a drug?
- Varies from drug to drug, does not vary from dose to dose, it helps determine how often a med must be given to maintain therapeutic levels
- What is the therapeutic index?
- A measure of relative safety of a drug, a ratio between the lethal dose and the effective dose, a ratio closer to 1 indicates less safety
- What is the diffference between side effects and adverse reactions
- The severity. Some side effects are nauseousness, constipation, adverse reactions can be fatal
- When is the most dangerous time for a potential of fetal harm?
- first trimester, major organs and skeleton developing
- What are the two basic divisions of the GI tract?
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1. The alimentary canal (starts with the mouth, ends with the anus)
2. Accessory organs of digestion (salivary glands, liver, pancreas, gallbladder) - What is peristalsis?
- The process whereby substances are propelled along the GI tract, a progressive, wavelike, involuntary movement
- What is Peptic Ulcer Disease (PUD)?
- A common GI tract disorder, erosion of the mucosal lining of either the stomach (gastric ulcer) or the small intestine (duodenal ulcer)
- What are the risk factors to PUD?
- Family history, blood group O, Tobacco use, caffeine, some meds (steroids,asa, nsaids), stress, the primary cause is infection with Helicobacter Pylori
- What are some ulcer symptoms?
- Pain, GI tract bleeding, anorexia, vomiting
- What is gastroesophageal reflux disease (GERD)?
- Acidic contents of stomach move backwards into the esophagus which may cause esophageal ulcers, surgery may be only correction, weakening of spincter causes severe burning or discomfort
- What are the major drugs for treating PUD's and GERD's
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5 classes:1. H2 receptor antagonists
2. proton pump inhibitors
3. Antacids
4. Antibiotics
5. Miscellaneous - How do H2 receptor antagonists work?
- histamine blockers, stimulates H2 receptors to increase gastric acid secretion
- What do proton pump inhibitors do?
- They suppress gastric acid secretion by blocking the enzyme responsible for hydrochloride production in the stomach, short term therapy
- What are some examples of proton pump inhibitors?
- Prilosec (prototype), protonix, nexium, prevacid, etc
- What are antacids?
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OTC drugs, alkaline substances that neutralize gastric contents
Amphojel (prototype), Tums, Mylanta - Because many ulcers are related to Helicobacter Pylori what may they be treated with?
- Antibiotics, Flagyl (Metronidazole), Biaxin (clarithromycin), Tetracycline, Amoxil
- What are some of the miscellaneous drugs used to treat ulcers?
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1. Cytoprotective agents-coat the stomach lining, sucralfate and misoprostol (preg cat x)(prevents gastric acid secretion stimulates mucus
2. Anticholinergics - What are some drugs for constipation?
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Piates, Antacids, Chemo agents
Most are OTC, others are Lactulose (chronulac) and Golytely - What are some prescription anti-diarrheals?
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Opioids(most effective), Lomotil, Motofen, Paregoric
Some OTC are Loperamide (Immodium), Kaopectate and Pepto-bismol - How do anti-emetics work and what are some drugs
- Meds which stop or decrease nausea and or vomiting protoype (prochloroperazine) Compazine. Cat. Benzodiazipines, anticholinergics, anti-histamines,cannabinoids
- What are anorexients?
- Medications to decrease appetite, highly addictive, Meridia most widely used (preg cat c)
- Who may need nutrional supplements?
- Alcoholics, cancer patients, chronic inflammatory bowel disease, GI problems, burns, Hiv patients
- What is enteral nutrition?
- Any feeding through the GI tract-oral, NG or G-tube, may cause diarrhea or constipation
- What is parenteral nutrition?
- TPN Total Parenteral Nutrition, feedings through a vein for someone whose GI tract cannot accept or absorb food in any form, through a central or peripheral vein
- What is the sublingual route?
- the medication is placed under the tongue and allowed to slowly dissolve
- What is the buccal route?
- the tablet or capsule is placed in the oral cavity between the gum and the cheek
- What is the parenteral route?
- delivers drugs via a needle into the skin layers, subcutaneous tissue, muscles or veins intrathecal(body cavity or artery), intracardiac(into heart)
- What are the intradermal and subcutaneous routes?
- Intradermal delivers drugs into the dermis layer of the skin, Subcutaneous is delivered into the deepest layes of the skin